The
bill, introduced by state Sen. Ed Hernandez, D-West Covina, and
sponsored by three statewide health advocacy and consumer groups, was
proposed in response to numerous complaints by California residents who
enrolled into health plans through Covered California beginning in October 2013 only to find inaccurate provider directories, no doctors in the networks chosen and other mistakes.

California
consumers need to know which doctors and hospitals are in plan networks
when they are choosing and using their health coverage, to keep care
affordable and avoid surprise out-of-network charges,” said Betsy
Imholz, special projects director for Consumers Union, the advocacy and
policy arm of nonprofit Consumer Reports. “By setting uniform standards
for directory elements, with frequent updates, this bill lays the
groundwork for creating a consolidated statewide directory across plans
for truly informed consumer choice.”

Results of a state audit
on Medi-Cal released in June found that Anthem Blue Cross, Health Net
and Partnership Health Plan had many errors in their directories,
including incorrect telephone numbers and addresses, or information
about whether they were accepting new patients.

The bill places
pressure on health insurance providers by making them reimburse an
enrollee who ends up paying for out-of-network service because of
inaccurate information. The bill goes further, suggesting penalties if
there is a lack of communication between health insurers and providers.

It would “authorize a plan or health insurer to delay payment or
reimbursement owed to a provider or provider group, as specified, if the
provider or provider group fails to respond to the plan’s or health
insurer’s attempts to verify the provider’s or provider group’s
information.”

But
the changes were needed, especially after thousands of people who began
to enroll into plans through Covered California discovered that an
online directory contained many inaccuracies. Covered California, the
state’s health exchange established under the Affordable Care Act,
discontinued the directory in February 2014.

“The new law will make it easier for consumers shopping for
health coverage to find a doctor who speaks their language or ensure
their current bilingual provider is in their plan,” said Sarah de Guia,
executive director of the CPEHN. “The law also strengthens consumer
protections by requiring health plans to include a notice in the
directory informing consumers about language assistance services. SB 137
is a critical tool for all Californians and will help improve access to
care.”

Anthony Wright, executive director of Health Access California, said the new law will help consumers make better decisions.

“Just as we don’t allow grocery stores to sell food mislabeled
with the wrong ingredients we shouldn’t allow insurers to sell health
plans without accurate provider directories,” Wright said. “Our hope is
that over time this will make the marketplaces more responsive to
consumer demand for accessible, high-quality care.”